# 2ND HOME PERTH AMBOY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548304223
- **Authorized official:** DAVID M MYERS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (973) 278-7065

## Contact information

- **Practice address:** 420 FAYETTE ST, PERTH AMBOY, NJ 08861-3835
- **Practice address phone:** (732) 826-1961
- **Practice address fax:** (973) 278-4773
- **Mailing address:** 100 HAMILTON PLZ, 3RD FLOOR, PATERSON, NJ 07505-2109
- **Mailing address phone:** (973) 278-7065
- **Mailing address fax:** (973) 278-4773

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | Z0SFLR | NJ | Yes |

## Other

- **Enumeration date:** 02/16/2007
- **Last updated:** 06/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7337043 | — | NJ |